The need for urgent care clinics is based on an AIHW model that is significantly off the mark, according to a new study.
The data used to justify urgent care clinics is flawed, say Australian researchers who have published a new study in the Medical Journal of Australia.
The researchers said it was a “misconception” that overcrowding in emergency departments was caused by large numbers of people with problems that could be managed by general practitioners.
Their findings hinge on Australian Institute of Health and Welfare (AIHW) data that uses the Australasian Triage Scale model to assess which patients in an ED could have been treated in a general practice.
“The AIHW definition should not be used when formulating health policy, planning, or allocating resources,” the authors wrote.
“The ATS is an urgency scale, not a complexity scale. A patient can have a low triage category but need complex care.”
The Nepean Hospital-based researchers found that more than three-quarters of patients deemed suitable for GP care by the AIHW criteria needed to be treated at a hospital due to the complexity of their conditions.
This is the third study in the past 15 years to raise questions about the data that determines who who needs to be in an ED.
A 2013 study published in the MJA said, “The AIHW methodology overestimates the actual proportion of general practice-type patient attendances”.
A 2009 study, also published in the MJA, busted common myths about overcrowding in EDs and found that “There is no evidence that telephone advice lines or collocated after-hours GP services assist in reducing ED workloads”.
“Changes to ED structure and function do not address the underlying causes or major adverse effects of overcrowding. They are also rapidly overwhelmed by increasing access block,” the authors of the 2009 study wrote.
“The causes of overcrowding, and hence the solutions, lie outside the ED. Solutions will mainly be found in managing hospital bed stock and systemic capacity [including the use of step-down and community resources] so that appropriate inpatient beds remain available for acutely sick patients.”
According to the AIHW website, ED presentations that were lower urgency were sometimes used as a proxy measure of access to primary health care.
“Higher presentation rates may suggest a lack of access to GPs or other primary health services, which may have been better placed to manage a person’s health condition,” the AIHW states.
An AIHW spokesperson told The Medical Republic that, “‘This is an indicator the AIHW has historically reported on because it was agreed to by governments as part of a national healthcare agreement”.
Health departments are struggling to reduce ED loads and urgent care clinics (UCCs) have been touted as the solution.
They emerged as a Labor government idea in April last year, when federal Health Minister Mark Butler said they would be “a level of care somewhere between what you get at a standard general practice and a fully-equipped hospital”.
He said UCCs would be “fully free and bulk-billed” and “open every day between 8am and 10pm”. They would cost $135 million over four years and there would be 50 of them across the country.
However during a Senate hearing on budget estimates in June, DoHAC officials confirmed only 17 are expected to be delivered in the promised timeframe of December 2023.
Aside from the government’s lag on implementation a much larger issue is brewing and reflects concerns about UCCs raised by peak doctors’ groups.
Tracey Johnson, Chief Executive of Inala Primary Care, said she was very concerned about the impact of UCCs and said they were no silver bullet to overcrowded EDs.
Ms Johnson said that latest MJA research was “game changing in the healthcare debate and puts a cloud over urgent care clinics”.
“Increasingly, urgent care clinics are going to be where the poor and disenfranchised go for healthcare,” she said.
“If a patient is disenfranchised, they’re likely to have complex health conditions. Yet we’re going to give them an acute care model, not a comprehensive team-based care model which is, in every other part of the world, where you save costs.”
Ms Johnson said UCCs were, “in theory”, for patients who can’t get in to see their GP.
“I would argue that that’s actually a much smaller group than is imagined,” she said.
However, she acknowledged that some general practices did not allow ample time for walk-in patients with urgent need.
“This is one of the problems with an activity based model,” she said.
“Some doctors will prioritise patients who are prepared to book in advance rather than leave gaps in the diary. Because if there’s nothing in the diary they don’t get paid.”
Ms Johnson said the government funding for UCCs could be better used.
“Instead of pumping money into an urgent care clinics, can you please just give primary care the money to employ pharmacists and nurse practitioners?” she asked.
“I would be able to take on many more patients and the whole notion of access block wouldn’t exist. Pharmacists and nurse practitioners in primary care are significantly cheaper than creating an entirely new building with an entirely new team of urgent care clinic doctors, nurses and admin staff.”
Ms Johnson called for a broadening of what was permitted and funded in local GP clinics.
“If the Medicare schedule was adjusted, and GPs had the right to order additional scans and pathology, we’d be able to keep some of those people out of EDs,” she said.
UCCs were “not even a Band-Aid” for overloaded EDs, Ms Johnson said.
“If you’ve got a 40cm wound and you put five Band-Aids on it, you’re still going to have an open wound,” she said.
The Department of Health and Aged Care had not responded to questions by the time of publication.
